Demand for surgical procedures which drastically reduce patient recovery time and discomfort has led to a paradigm shift in modern medicine. Minimally invasive surgery (MIS) is a rapidly developing medical practice and is constantly being advanced through the introduction of novel experimental procedures. MIS procedures require smaller external incisions than traditional surgery, or are completely devoid of external incisions. The benefits of such procedures from a patient care perspective include less discomfort and scaring, shortened recovery time and decreased chance of surgical infections. These benefits have caused an extremely high demand for MIS over traditional surgery, resulting in the introduction of several groundbreaking procedures.
The scope of endoscopic therapy for diseases has significantly broadened with the use of techniques allowing dissection of the layers of the stomach and selective removal of superficial layers. Several previously open surgical procedures can now be accomplished through minimally invasive endoscopic procedures. Furthering of this field requires tools adapted for flexible endoscopic application.
A procedure known as natural orifice transluminal endoscopic surgery (NOTES) is particularly promising as a minimally invasive technique. During NOTES, the surgeon passes a flexible endoscope through a natural orifice, e.g. the mouth or anus, in order to access an internal surgical site.
A novel NOTES procedure for transgastric access is currently under development. During this experimental procedure, the endoscope is inserted through the esophagus and a small internal incision is made in the inner lining of the stomach. The surgeon then passes a forceps tool through the endoscope and tunnels between the layers of the stomach wall, subsequently making a second incision in the outer layer of the stomach. Tunneling between the layers of the stomach wall creates an effective seal between the acidic inside of the stomach and the abdominal cavity, preventing unwanted leakage. After the procedure has concluded, no external incisions are present, and the internal incisions are sutured.
The tunneling procedures and dissection of tissue using millimeter scale has proven to be extremely tedious using modern endoscopic tools. At small scales, such as 1-5 mm diameter or less, current tool designs are not capable of applying large spreading forces, thereby greatly impeding the ability to separate and dissect tissue. Dissection of tissue is key in any surgery and irrespective of the location and minimally invasive technique, small tools capable of tissue dissection and separation, that pass through the small channels of the current and envisioned endoscopes and other surgical devices are needed. Without these minimally invasive and NOTES procedures cannot to develop and advance effectively.
There is presently a dearth of multifunctional surgical tools for use in endoscopy. Exchanging the tool tip at the distal end of an endoscope is not only tedious but also undesirably extends the length of a surgical procedure. There is a continuing need for multifunctional surgical tools for use in endoscopy.